Paraplegia following epidural steroid injection is, fortunately, an exceedingly rare complication. The differential diagnosis includes epidural hematoma, spinal cord injury/infarction, epidural abscess, and conversion disorder. Less likely diagnoses include worsening of underlying pathology, a new compressing lesion, or subarachnoid injection.
The artery of Adamkiewicz enters the spinal canal via the neural foramen and provides blood supply to the lower two thirds of the spinal cord via the anterior spinal artery. Avoidance of the artery during a transforaminal epidural steroid injection is facilitated by entering the inferior portion of the foramen.
Acute management of neurologic complications arising from an epidural steroid injection is facilitated by rapid identification of etiology. In the case of epidural hematoma, avoidance of permanent deficit is more likely when patients undergo prompt decompression. The role of intravenous steroids in acute spinal cord injury is controversial. Chronic management includes extensive rehabilitation, including physical and occupational therapy. Treatment of musculoskeletal nociceptive pain, such as due to shoulder overuse, and neuropathic pain is vital to optimize the patient’s participation in rehabilitative therapy.
Keywords: Epidural Steroid Injection; Complications; Spinal Cord Injury; Epidural Hematoma; Epidural Abscess; Artery of Adamkiewicz; Anterior Spinal Artery Syndrome; Particulate Steroid; Fluoroscopic Guidance
Spinal cord infarction caused by sacral canal epidural steroid injection